39D2190165 CLIA NUMBER - GPHA CRISTO REY HEALTH SUITE

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Laboratory Demographics

CLIA Number: 39D2190165

Facility Name: GPHA CRISTO REY HEALTH SUITE

Facility Address:
1717 W ALLEGHENY AVENUE, 2ND FLOOR, NC OFFICE
PHILADELPHIA, PA
ZIP 19132
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Facility Phone Number: 215 925-2400

Facility Type: School/Student Health Service

Certificate Type: Waiver

NPI Number: 1326493321

Taxonomy: 261QD0000X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	39D2190165
LAB Type	School/Student Health Service
Facility Name	GPHA CRISTO REY HEALTH SUITE
Street	1717 W ALLEGHENY AVENUE, 2ND FLOOR, NC OFFICE
City	PHILADELPHIA
State	PA
ZIP	19132
Phone	215 925-2400
CertificateType	4
CertificateEffectiveDate	8/31/2023
CertificateExpirationDate	8/30/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024